Study identifies factors linked to dying comfortably for the very old
Improved training for community palliative care should be a priority, in order to make life more comfortable for the growing number of older old people, researchers have said.
Very old people are more likely to die comfortably if they die in a care home or at home, compared with dying in a hospital, a new nurse-led study suggest.
Yet while the overwhelming majority of very old people – the University of Cambridge study focused on people aged between 79 to 107 – reported symptoms at the end of life – such as distress, pain and depression – researchers found that these were not always treated effectively.
Need to improve training
The authors argue that it highlights the need to improve training in end of life care for all staff, at all levels and in all settings.
Nurse academic and the study’s first author Jane Fleming, from the Department of Public Health and Primary Care, said: ‘How we care for the oldest members of society towards the end of their lives is one of the big issues for societies across the world.
‘The UK is not the only country where an urgent review of the funding for older people’s long-term care is needed, along with commitments to staff training and development in this often undervalued sector.
‘It’s heartening that the majority of very old people in our study, including those with dementia, appear to have been comfortable at the end of life. But we need to do more to ensure that everyone is able to die comfortably, wherever they are.’
Proportion of deaths
Researchers from the Cambridge Institute for Public Health said in the UK the proportion of deaths occurring at the age of 85 or older has risen steeply from around one in five in 1990, to almost half of all deaths.
In their study, researchers examined the association between factors related to comfort during older people’s final illness. This included physical and cognitive disability, place of care, transitions in their final illness, and place of death.
This involved a retrospective analysis of data for 180 study participants aged between 79 and 107 years.
Those who died in care homes or at their usual address were four times more likely to die comfortably than those in hospitals.
Two or more symptoms
Just one in ten participants died without symptoms of distress, pain, depression, delirium or confusion, and most people had experienced combinations of two or more of these symptoms.
Of the treatable symptoms reported, pain was addressed in the majority, but only effectively for half of these; only a fraction of those with depression received treatment for their symptom.
Co-author Morag Farquhar said improving access to supportive and palliative care in the community should be a priority, ‘otherwise staying at home may not always be the most comfortable setting for end-of-life care, and inadequacies of care may lead to admission before death in hospital’.
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